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N A T I O N A L I N S T I T U T E O N D R U G A B U S E

Research Report S E R I E S
In the 1970s, the baby boom
generation was coming of age, and
its drug of choice was marijuana.
By 1979, more than 60 percent of
12th-graders had tried marijuana
at least once in their lives. From this
peak, the percentage of 12th-graders
MARIJUANA
who had ever used marijuana
decreased for more than a decade,
dropping to a low of 33 percent in
Abuse
1992. However, in 1993, first-time
marijuana use by 12th-graders was
on the upswing, reaching 50 percent
What is marijuana? The major active chemical in
marijuana is delta-9-tetrahydro-

M
by 1997. Although the percentage arijuana—often called pot,
of 12th-graders who have experience cannabinol (THC), which causes
grass, reefer, weed, herb,
with marijuana has remained the mind-altering effects of mari-
mary jane, or mj—is a juana intoxication. The amount
roughly level since then, there is
still reason to be concerned.1 In greenish-gray mixture of the dried, of THC (which is also the psycho-
2002, an estimated 2.6 million shredded leaves, stems, seeds, active ingredient in hashish) deter-
Americans used marijuana for the and flowers of Cannabis sativa, mines the potency and, therefore,
first time. Roughly two-thirds of the hemp plant. Most users smoke
from the director

them were under age 18.2 Further-


the effects of marijuana. Between
marijuana in hand-rolled cigarettes 1980 and 1997, the amount of
more, the marijuana that is
available today can be 5 times
called joints, among other names; THC in marijuana available in the
more potent than the marijuana some use pipes or water pipes United States rose dramatically.7
of the 1970s. called bongs. Marijuana cigars
The use of marijuana can called blunts have also become
produce adverse physical, mental, popular. To make blunts, users What is the scope
emotional, and behavioral changes,
and—contrary to popular belief—it
slice open cigars and replace the of marijuana use in
tobacco with marijuana, often
can be addictive. Marijuana smoke,
like cigarette smoke, can harm the combined with another drug, the United States?

M
lungs.3 The use of marijuana can such as crack cocaine. Marijuana arijuana is the Nation’s
impair short-term memory,4 verbal also is used to brew tea and is most commonly used
skills, and judgment and distort
sometimes mixed into foods. illicit drug. More than
perception. It also may weaken
the immune system 5 and possibly 94 million Americans
increase a user’s likelihood of (40 percent) age 12 and
developing cancer. Finally, the older have tried marijuana
increasing use of marijuana by at least once, according to
very young teens may have a the 2003 National Survey
profoundly negative effect upon on Drug Use and Health
their development.6
We hope that this research report (NSDUH).
will help make readers aware of Marijuana use is wide-
our current knowledge of marijuana spread among adolescents
abuse and its harmful effects. and young adults. The per-
centage of middle school
Nora D.Volkow, M.D. students who reported
Director
National Institute on Drug Abuse
using marijuana increased
throughout the early 1990s.

U.S. Department of Health and Human Services • National Institutes of Health


2 NIDA RESEARCH REPORT SERIES

In the past few years, according the patients between the ages of be compounded by the risks of
to the 2004 Monitoring the Future 12 and 17, and almost two-thirds added drugs, as well.
Survey, an annual survey of drug male.8
use among the Nation’s middle
and high school students, illicit
In 2002, the National Institute
of Justice’s Arrestee Drug Abuse
How does marijuana
drug use by 8th-, 10th-, and 12th- Monitoring (ADAM) Program, affect the brain?
graders has leveled off. Still, in which collects data on the number

S
2004, 16 percent of 8th-graders cientists have learned a great
of adult arrestees testing positive
reported that they had tried deal about how THC acts
for various drugs, found that, on
marijuana, and 6 percent were in the brain to produce its
average, 41 percent of adult male
current users (defined as having many effects. When someone
arrestees and 27 percent of adult smokes marijuana, THC rapidly
used the drug in the 30 days female arrestees tested positive for
preceding the survey). Among passes from the lungs into the
marijuana.9 On average, 57 percent bloodstream, which carries the
10th-graders, 35 percent had tried
of juvenile male and 32 percent of chemical to organs throughout the
marijuana sometime in their lives,
juvenile female arrestees tested body, including the brain. In the
and 16 percent were current users.
positive for marijuana. brain, THC connects to specific
As would be expected, rates of
use among 12th-graders were NIDA’s Community Epidemiology sites called cannabinoid receptors
higher still. Forty-six percent had Work Group (CEWG), a network on nerve cells and thereby influ-
tried marijuana at some time, and of researchers that tracks trends ences the activity of those cells.
20 percent were current users. in the nature and patterns of Some brain areas have many
The Drug Abuse Warning drug use in major U.S. cities, cannabinoid receptors; others
Network (DAWN), a system for consistently reports that marijuana have few or none. Many cannabi-
monitoring the health impact of frequently is combined with other noid receptors are found in the
drugs, estimated that, in 2002, drugs, such as crack cocaine, PCP, parts of the brain that influence
marijuana was a contributing factor formaldehyde, and codeine cough pleasure, memory, thought,
in over 119,000 emergency depart- syrup, sometimes without the user concentration, sensory and time
ment (ED) visits in the United being aware of it. Thus, the risks perception, and coordinated
States, with about 15 percent of associated with marijuana use may movement.

Long-Term Trends in Lifetime* Marijuana Use by 12th-Graders

■ Marijuana/Hashish
70
■ ■ ■ ■
■ ■ ■ ■ ■
60
■ ■ ■
■ ■ ■ ■ ■ ■ ■ ■
Percent Ever Used

50
■ ■
■ ■ ■ ■ ■

■ ■
40
30
20
10
0
’75 ’76 ’77 ’78 ’79 ’80 ’81 ’82 ’83 ’84 ’85 ’86 ’87 ’88 ’89 ’90 ’91 ’92 ’93 ’94 ’95 ’96 ’97 ’98 ’99 ’00 ’01 ’02 ’03 ’04
Year
*at least once in a lifetime
Source: The Monitoring the Future Survey, the University of Michigan
NIDA RESEARCH REPORT SERIES 3
Marijuana’s Effects on the Brain

Brain Region Functions Associated With Region


Cingulate Cortex Par
ieta
l Lo
Brain regions in which cannabinoid receptors are abundant
be
Cerebellum Body movement coordination
e
ob
lL
nta

Hippocampus Learning and memory


Fro

Cerebral cortex, especially cingulate, Higher cognitive functions


frontal, and parietal regions
Nucleus accumbens Reward
Basal ganglia Movement control
llum

Hypothalamus Substantia nigra pars reticulata


ebe

Bra
Amygdala in Entopeduncular nucleus
Cer

Ste
m Globus pallidus
Hippocampus
Spinal Cord Putamen
Brain regions in which cannabinoid receptors are moderately concentrated
Hypothalamus Body housekeeping functions (body temperature
When marijuana is smoked, its active ingredient, regulation, salt and water balance, reproductive
THC, travels throughout the body, including the function)
brain, to produce its many effects. THC attaches to Amygdala Emotional response, fear
sites called cannabinoid receptors on nerve cells
Spinal cord Peripheral sensation, including pain
in the brain, affecting the way those cells work.
Cannabinoid receptors are abundant in parts of Brain stem Sleep and arousal, temperature regulation,
the brain that regulate movement, coordination, motor control
learning and memory, higher cognitive functions Central gray Analgesia
such as judgment, and pleasure. Nucleus of the solitary tract Visceral sensation, nausea and vomiting

What are the passages relax and become


enlarged, and blood vessels in
A marijuana user may experi-
ence pleasant sensations, colors
acute effects of the eyes expand, making the eyes and sounds may seem more
look red. The heart rate, normally intense, and time appears to pass
marijuana use? 70 to 80 beats per minute, may very slowly. The user’s mouth

W
hen marijuana is smoked, increase by 20 to 50 beats per feels dry, and he or she may
its effects begin immedi- minute or, in some cases, even suddenly become very hungry
ately after the drug enters double. This effect can be greater and thirsty. His or her hands
the brain and last from 1 to 3 if other drugs are taken with may tremble and grow cold.
hours. If marijuana is consumed marijuana. The euphoria passes after awhile,
in food or drink, the short-term As THC enters the brain, it and then the user may feel sleepy
effects begin more slowly, usually causes a user to feel euphoric— or depressed. Occasionally,
in 1/2 to 1 hour, and last longer, or “high”—by acting in the brain’s marijuana use produces anxiety,
for as long as 4 hours. Smoking reward system, areas of the brain fear, distrust, or panic.
marijuana deposits several times that respond to stimuli such as Heavy marijuana use impairs a
more THC into the blood than food and drink as well as most person’s ability to form memories,
does eating or drinking the drug. drugs of abuse. THC activates recall events (see Marijuana,
Within a few minutes after the reward system in the same Memory, and the Hippocampus),
inhaling marijuana smoke, an way that nearly all drugs of abuse and shift attention from one thing
individual’s heart begins beating do, by stimulating brain cells to to another.10 THC also disrupts
more rapidly, the bronchial release the chemical dopamine. coordination and balance by
4 NIDA RESEARCH REPORT SERIES

binding to receptors in the cere-


bellum and basal ganglia, parts Marijuana, Memory, and the Hippocampus
of the brain that regulate balance,
posture, coordination of move-
ment, and reaction time. Through
its effects on the brain and body,
marijuana intoxication can cause
M arijuana’s damage to short-term memory seems to occur
because THC alters the way in which information is pro-
cessed by the hippocampus, a brain area responsible for memory
accidents. Studies show that
formation. Laboratory rats treated with THC displayed the same
approximately 6 to 11 percent of
fatal accident victims test positive reduced ability to perform tasks requiring short-term memory as
for THC. In many of these cases, other rats showed after nerve cells in their hippocampus were de-
alcohol is detected as well.11 stroyed. In addition, the THC-treated rats had the greatest difficulty
In a study conducted by the with the tasks precisely during the time when the drug was interfer-
National Highway Traffic Safety ing most with the normal functioning of cells in the hippocampus.
Administration, a moderate dose
As people age, they normally lose neurons in the hippocampus,
of marijuana alone was shown to
impair driving performance; how- which decreases their ability to remember events. Chronic THC
ever, the effects of even a low exposure may hasten the age-related loss of hippocampal neurons.
dose of marijuana combined with In one series of studies, rats exposed to THC every day for
alcohol were markedly greater 8 months (approximately 30 percent of their lifespan), when
than for either drug alone.12 examined at 11 to 12 months of age, showed nerve cell loss
Driving indices measured included equivalent to that of unexposed animals twice their age.
reaction time, visual search
frequency (driver checking side
streets), and the ability to perceive
and/or respond to changes in the only tobacco. The relationship Cancer of the respiratory tract
relative velocity of other vehicles. between marijuana use and con- and lungs may also be promoted
Marijuana users who have tinued smoking was particularly by marijuana smoke.3 A study
taken high doses of the drug may strong in those who smoked comparing 173 cancer patients
experience acute toxic psychosis, marijuana daily at the time of the and 176 healthy individuals
which includes hallucinations, de- initial interview, 13 years prior to produced strong evidence that
lusions, and depersonalization— the followup interview. smoking marijuana increases the
a loss of the sense of personal A study of 450 individuals likelihood of developing cancer
identity, or self-recognition. found that people who smoke of the head or neck, and that the
Although the specific causes of marijuana frequently but do not more marijuana smoked, the
these symptoms remain unknown, smoke tobacco have more health greater the increase. A statistical
they appear to occur more fre- problems and miss more days of analysis of the data suggested that
quently when a high dose of work than nonsmokers do. Many marijuana smoking doubled or
cannabis is consumed in food of the extra sick days used by the tripled the risk of these cancers.
or drink rather than smoked. marijuana smokers in the study Marijuana has the potential to
were for respiratory illnesses. promote cancer of the lungs and
How does marijuana Even infrequent marijuana use
can cause burning and stinging
other parts of the respiratory tract
because it contains irritants and
use affect physical of the mouth and throat, often carcinogens. In fact, marijuana
accompanied by a heavy cough. smoke contains 50 percent to
health? Someone who smokes marijuana 70 percent more carcinogenic

M
arijuana use has been regularly may have many of the hydrocarbons than does tobacco
shown to increase users’ same respiratory problems that smoke. It also produces high
difficulty in trying to quit tobacco smokers do, such as daily levels of an enzyme that converts
smoking tobacco.13 This was cough and phlegm production, certain hydrocarbons into their
reported in a study comparing more frequent acute chest illnesses, carcinogenic form, levels that
smoking cessation in adults who a heightened risk of lung infec- may accelerate the changes that
smoked both marijuana and tions, and a greater tendency ultimately produce malignant
tobacco with those who smoked toward obstructed airways.3 cells. Marijuana users usually
NIDA RESEARCH REPORT SERIES 5
inhale more deeply and hold their
breath longer than tobacco smok- How does marijuana worse. Because marijuana com-
promises the ability to learn and
ers do, which increases the lungs’ use affect school, remember information, the more a
exposure to carcinogenic smoke. person uses marijuana the more
These facts suggest that, puff for work, and social life?

S
puff, smoking marijuana may tudents who smoke marijuana
increase the risk of cancer more get lower grades and are less
than smoking tobacco does. likely to graduate from high The Science of
Some adverse health effects school, compared with their non- Medical Marijuana
caused by marijuana may occur smoking peers.6, 14
because THC impairs the immune Workers who smoke marijuana
system’s ability to fight off infec- are more likely than their co-
tious diseases and cancer. In labo-
ratory experiments that exposed
animal and human cells to THC
workers to have problems on the
job. Several studies have associated THC, the main active
ingredient in mari-
juana, produces effects that
workers’ marijuana smoking with
or other marijuana ingredients, increased absences, tardiness, potentially can be useful for
the normal disease-preventing accidents, workers’ compensation treating a variety of medical
reactions of many of the key types claims, and job turnover. A study conditions. It is the main ingre-
of immune cells were inhibited.5 among postal workers found that dient in an oral medication
In other studies, mice exposed to employees who tested positive that is currently used to treat
THC or related substances were for marijuana on a pre-employment nausea in cancer chemotherapy
more likely than unexposed mice urine drug test had 55 percent more patients and to stimulate
to develop bacterial infections industrial accidents, 85 percent appetite in patients with wasting
and tumors. more injuries, and a 75-percent
One study has indicated that a due to AIDS. Scientists are
increase in absenteeism compared
person’s risk of heart attack dur- with those who tested negative for continuing to investigate other
ing the first hour after smoking marijuana use. potential medical uses for
marijuana is four times his or her Depression, anxiety, and cannabinoids.22
usual risk. The researchers suggest personality disturbances are all
that a heart attack might occur, associated with marijuana use. Research is underway to
in part, because marijuana raises Research clearly demonstrates that examine the effects of smoked
blood pressure and heart rate marijuana use has the potential marijuana and extracts of
and reduces the oxygen-carrying to cause problems in daily life or marijuana on appetite stimu-
capacity of blood. make a person’s existing problems lation, certain types of pain,
and spasticity due to multiple
sclerosis. However, the incon-
Health Consequences of Marijuana Abuse sistency of THC dosage in
different marijuana samples
poses a major hindrance to
Acute (present during intoxication) valid trials and to the safe
■ Impairs short-term memory and effective use of the drug.
■ Impairs attention, judgment, and other cognitive functions Moreover, the adverse effects
■ Impairs coordination and balance of marijuana smoke on the
■ Increases heart rate respiratory system 3 will offset
Persistent (lasting longer than intoxication, but may not be permanent) the helpfulness of smoked mari-

juana for some patients. Finally,
Impairs memory and learning skills
little is known about the many
Long-term (cumulative, potentially permanent effects of chronic abuse) chemicals besides THC that are
■ Can lead to addiction in marijuana, or their possible
■ Increases risk of chronic cough, bronchitis, and emphysema deleterious impact on patients
■ Increases risk of cancer of the head, neck, and lungs with medical conditions.
6 NIDA RESEARCH REPORT SERIES

he or she is likely to fall behind


in accumulating intellectual, job,
Another study produced addi-
tional evidence that marijuana’s
Can marijuana use
or social skills. In one study of effects on the brain can cause during pregnancy
cognition, adults were matched cumulative deterioration of
on the basis of their performance critical life skills in the long run. harm the baby?

R
in the 4th grade on the Iowa Test Researchers gave students a battery esearch has shown that
of Basic Skills. They were evalu- of tests measuring problem-solving some babies born to women
ated on a number of cognitive and emotional skills in 8th grade who used marijuana during
measures including the 12th-grade and again in 12th grade. The their pregnancies display altered
version of the Iowa Test. Those results showed that the students responses to visual stimuli,
who were heavy marijuana who were already drinking
smokers scored significantly lower increased tremulousness, and
alcohol plus smoking marijuana a high-pitched cry, which may
on mathematical skills and verbal
in 8th grade started off slightly indicate problems with neurolo-
expression than nonsmokers.
behind their peers, but that the gical development. During the
Moreover, research has shown
distance separating these two preschool years, marijuana-
that marijuana’s adverse impact
groups grew significantly by exposed children have been
on memory and learning can last
their senior year in high school. observed to perform tasks
for days or weeks after the acute
The analysis linked marijuana involving sustained attention
effects of the drug wear off.16 For
use, independently of alcohol and memory more poorly than
example, a study of 129 college
use, to reduced capacity for self- nonexposed children do.17 In the
students found that among heavy
users of marijuana—those who reinforcement, a group of psycho- school years, these children are
smoked the drug at least 27 of logical skills that enable individuals more likely to exhibit deficits in
the preceding 30 days—critical to maintain confidence and problem-solving skills, memory,
skills related to attention, memory, persevere in the pursuit of goals.
and the ability to remain
and learning were significantly Marijuana users themselves
attentive.17
impaired, even after they had report poor outcomes on a variety
of measures of life satisfaction and
not used the drug for at least
24 hours.10 The heavy marijuana achievement. A recent study com- Is marijuana
users in the study had more trou- pared current and former long-
term heavy users of marijuana
use addictive?

L
ble sustaining and shifting their ong-term marijuana use can
attention and in registering, organ- with a control group who reported
smoking cannabis at least once lead to addiction for some
izing, and using information than
in their lives, but not more than people; that is, they use the
did the study participants who
50 times. Despite similar educa- drug compulsively even though it
had used marijuana no more than
tion and incomes in their families often interferes with family, school,
3 of the previous 30 days. As a
result, someone who smokes of origin, significant differences work, and recreational activities.
marijuana once daily may be func- were found in educational attain- According to the 2003 National
tioning at a reduced intellectual ment and income between heavy Survey on Drug Use and Health
level all of the time. More recently, users and the control group: fewer (NSDUH), an estimated 21.6 million
the same researchers showed of the cannabis users completed Americans aged 12 or older were
that a group of long-term heavy college and more had household classified with substance depend-
marijuana users’ ability to recall incomes of less than $30,000. ence or abuse (9.1 percent of the
words from a list was impaired When asked how marijuana total population). Of the estimated
1 week following cessation of affected their cognitive abilities, 6.9 million Americans classified
marijuana use, but returned to career achievements, social lives, with dependence on or abuse of
normal by 4 weeks.16 An implica- and physical and mental health, illicit drugs, 4.2 million were
tion of this finding is that even the overwhelming majority of dependent on or abused marijuana.
after long-term heavy marijuana heavy cannabis users reported In 2002, 15 percent of people
use, if an individual quits marijuana the drug’s deleterious effect on entering drug abuse treatment
use, some cognitive abilities may all of these measures. programs reported that marijuana
be recovered. was their primary drug of abuse.
NIDA RESEARCH REPORT SERIES 7
Along with craving, withdrawal aggression on psychological tests, patients’ awareness of what triggers
symptoms can make it hard for peaking approximately 1 week their marijuana use, both treat-
long-term marijuana smokers to after they last used the drug. ments sought to help them devise
stop using the drug.15 People In addition to its addictive avoidance strategies. Use, depend-
trying to quit report irritability, liability, research indicates that ence symptoms, and psychosocial
difficulty sleeping, and anxiety. early exposure to marijuana can problems decreased for at least
They also display increased increase the likelihood of a life- 1 year after both treatments. About
time of subsequent drug problems. 30 percent of users were abstinent
A recent study of over 300 frater- during the last 3-month followup
The Body’s Natural nal and identical twin pairs, who period. Another study suggests
differed on whether or not they that giving patients vouchers for
THC-Like Chemicals used marijuana before the age of abstaining from marijuana can
17, found that those who had improve outcomes.19 Vouchers can
used marijuana early had elevated be redeemed for such goods as
THC owes many of its
effects to its similarity
to a family of chemicals called
rates of other drug use and drug
problems later on, compared with
movie passes, sports equipment,
or vocational training.
their twins, who did not use mari- No medications are now avail-
the endogenous cannabinoids, juana before age 17. This study able to treat marijuana abuse.
which are natural Cannabis- re-emphasizes the importance of However, recent discoveries about
like chemicals. Because a THC primary prevention by showing the workings of THC receptors
molecule is shaped like these that early drug initiation is associ- have raised the possibility that
endogenous cannabinoids, ated with increased risk of later scientists may eventually develop
it interacts with the same drug problems, and it provides a medication that will block THC’s
receptors on nerve cells, the more evidence for why preventing intoxicating effects. Such a med-
cannabinoid receptors, that marijuana experimentation during ication might be used to prevent
endogenous cannabinoids do, adolescence could have an impact relapse to marijuana abuse by
and it influences many of the on preventing addiction.18 reducing or eliminating its appeal.
same processes. Research has
shown that the endogenous
cannabinoids help control a
What treatments Where can I get
wide array of mental and are available for further scientific
physical processes in the brain
and throughout the body, marijuana abusers? information about
including memory and per-
T marijuana?
reatment programs directed
ception, fine motor coordina- solely at marijuana abuse are

T
tion, pain sensations, immunity rare, partly because many o learn more about marijuana
to disease, and reproduction. who use marijuana do so in com- and other drugs of abuse,
bination with other drugs, such as contact the National
When someone smokes cocaine and alcohol. However, Clearinghouse for Alcohol and
marijuana, THC overstimulates with more people seeking help to Drug Information (NCADI) at
the cannabinoid receptors, control marijuana abuse, research 1-800-729-6686. Information spe-
leading to a disruption of the has focused on ways to overcome cialists are available to help you
endogenous cannabinoids’ problems with abuse of this drug. locate information and resources.
normal function. This over- One study of adult marijuana Fact sheets, including InfoFacts,
stimulation produces the users found comparable benefits on the health effects of marijuana,
intoxication experienced by from a 14-session cognitive- other drugs of abuse, and
marijuana smokers. Over behavioral group treatment and a other drug abuse topics are
time, it may alter the function 2-session individual treatment that available on the NIDA Web site
of cannabinoid receptors, included motivational interviewing (www.drugabuse.gov), and can
which, along with other and advice on ways to reduce be ordered free of charge in
changes in the brain, can marijuana use. Participants were English and Spanish from NCADI
lead to withdrawal symptoms mostly men in their early thirties at www.health.org.
and addiction.20, 21 who had smoked marijuana daily
for over 10 years. By increasing
8 NIDA RESEARCH REPORT SERIES

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ElSohly, M.A.; Ross, S.A.; Mehmedic, Z.; Arafat, R.; JAMA 289:427–433, 2003.
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marijuana from 1980–1997. J Forensic Sci coping skills and motivational enhancement
• What’s new on the NIDA Web site 45(1):24–30, 2000.
improves outcomes during treatment for
• Information on drugs of abuse 8
Substance Abuse and Mental Health Services marijuana dependence. J Consult Clin Psychol
• Publications and communications Administration, Office of Applied Studies. 68(6):1051–1061, 2000.
(including NIDA NOTES) Emergency Department Trends From DAWN: 20
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SAMHSA, 2003.
• Funding information 9
21
Breivogel, C.S.; Scates, S.M.; Beletskaya, I.O.;
(including program announcements National Institute of Justice, Arrestee Drug Abuse
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and deadlines) effects of delta-9 tetrahydrocannabinol physical
Use & Related Matters Among Adult Arrestees
• International activities & Juvenile Detainees, 2002. Washington, DC: dependence on brain cannabinoid receptors.
• Links to related Web sites U.S. Department of Justice, 2002. Euro J Pharmacology 459:139–150, 2003.
(access to Web sites of many other 10
Pope, H.G.; and Yurgelun-Todd, D. The residual
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Piomelli, D.; Giuffrida, A.; Calignano, A.; and
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11 21:218–224, 2000.
NIDA Web Sites Cimbura, G.; Lucas, D.M.; Bennett, R.C.; and
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aspects of cannabis and ethanol detected in
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